Surgical treatment of cervical esophageal cancer: larynx-preserving esophagectomy with limited margin VS. total laryngectomy

doi:10.3877/cma.j.issn.2095-8773.2018.02.04

Abstract

Abstract:

Objective

To study the short-term results of larynx-preserving esophagectomy for cervical esophageal cancer.

Methods

A total of 35 patients with cervical esophageal squamous cell carcinoma undergoing surgical resection in Shanghai Chest Hospital from 2015 to 2017 were reviewed. 28 cases of larynx-preserving cervical or subtotal esophagectomy (LPE group) were selected as study subjects. 7 cases with cervical esophageal cancer undergoing fully laryngo-pharyngo-esophagectomy (TLPE group) and 88 cases with upper thoracic esophageal cancer (UTE group) were studied as control group.

Results

The average age of the LPE group was 61 years and the male were 96.4%. Except for one case of jejunum interposition, the stomach was chosen for conduit generally (96.4%). T3 patients accounted for 57.1%, and lymph node metastasis rate was 53.6% in LPE group. The R0 resection rate was 60.7%, and the R1 resection rate was 13.1% (positive proximal resection margin). The postoperative complications of TPLE, LPE and UTE were 42.9%, 25.0%, and 21.6%, respectively. With a median follow-up of 14.3 months, the recurrence rates of TPLE, LPE, and UTE were respectively 16.7%, 11.8%, and 23.1%. The mortality rates were 14.3%, 21.4%, and 17.0%, respectively.

Conclusions

larynx-preserving esophagectomy for cervical esophageal cancer can obtain safe perioperative recovery and possible long-term survival in patients with R0 resection. A positive proximal margin does not affect the survival outcome.

Key words: Esophageal cancer, Laryngeal-preserving surgery, Total laryngo-pharyngo-esophagectomy

Zhigang Li, Xiaobin Zhang, Xufeng Guo, Yifeng Sun, Yu Yang, Bin Li, Haiyong Gu, Rong Hua, Teng Mao. Surgical treatment of cervical esophageal cancer: larynx-preserving esophagectomy with limited margin VS. total laryngectomy[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(02): 85-90.

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Figures/Tables 4

References 10

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变量		TLPE组(N＝7)	LPE组(N＝28)	UPE组(N＝88)	t值/χ²值	P值
年龄(±s，岁)		60.1 ± 8.9	61.7 ± 7.9	63.6 ± 7.2	0.930	0.376
性别[n(%)]		?	?	?	4.518	0.104
?	男性	7(100)	27(96.4)	73(83.0)	?	?
?	女性	0	1(3.6)	15(17.0)	?	?
临床T分期[n(%)]		?	?	?	2.646	0.521
?	T1	0(0)	0(0)	4(4.5)	?	?
?	T2	2(28.6)	11(39.3)	26(29.5)	?	?
?	T3	4(57.1)	14(50.0)	50(56.8)	?	?
?	T4a	1(14.3)	3(10.7)	8(9.1)	?	?
临床N分期[n(%)]		?	?	?	0.573	0.966
?	N0	2(28.6)	10(35.7)	31(35.2)	?	?
?	N1	5(71.4)	17(60.7)	53(60.3)	?	?
?	N2	0(0)	1(3.6)	4(4.5)	?	?
肿瘤上切缘与颈静脉切迹距离(±s，mm)		59.3 ± 21.8	33.5 ± 15.7	－28.6 ± 21.5	10.950	<0.001
肿瘤长度(±s，mm)		43.4 ± 20.3	51.2 ± 28.4	53.7 ± 23.4	14.256	<0.001
替代器官[n(%)]		?	?	?	22.795	<0.001
?	胃	5(71.4)	27(96.4)	87(98.9)	?	?
?	结肠	0(0)	0(0)	1(1.1)	?	?
?	空肠	2(28.6)	1(3.6)	(0)	?	?
上提路径[n(%)]		?	?	?	3.521	<0.001
?	食管床	7(100)	18(64.3)	59(67.0)	?	?
?	胸骨后	0(0)	10(35.7)	29(33.0)	?	?
手术方式[n(%)]		?	?	?	59.827	<0.001
?	McKeown三切口	2(28.6)	25(89.3)	86(97.7)	?	?
?	经食管裂孔	3(42.6)	0(0)	2(2.3)	?	?
?	胸骨部分劈开	0(0)	2(7.1)	0(0)	?	?
?	空肠间置	2(28.6)	1(3.6)	0(0)	?	?

变量		TLPE组(N＝7)	LPE组(N＝28)	UPE组(N＝88)	t值/χ²值	P值
年龄(±s，岁)		60.1 ± 8.9	61.7 ± 7.9	63.6 ± 7.2	0.930	0.376
性别[n(%)]		?	?	?	4.518	0.104
?	男性	7(100)	27(96.4)	73(83.0)	?	?
?	女性	0	1(3.6)	15(17.0)	?	?
临床T分期[n(%)]		?	?	?	2.646	0.521
?	T1	0(0)	0(0)	4(4.5)	?	?
?	T2	2(28.6)	11(39.3)	26(29.5)	?	?
?	T3	4(57.1)	14(50.0)	50(56.8)	?	?
?	T4a	1(14.3)	3(10.7)	8(9.1)	?	?
临床N分期[n(%)]		?	?	?	0.573	0.966
?	N0	2(28.6)	10(35.7)	31(35.2)	?	?
?	N1	5(71.4)	17(60.7)	53(60.3)	?	?
?	N2	0(0)	1(3.6)	4(4.5)	?	?
肿瘤上切缘与颈静脉切迹距离(±s，mm)		59.3 ± 21.8	33.5 ± 15.7	－28.6 ± 21.5	10.950	<0.001
肿瘤长度(±s，mm)		43.4 ± 20.3	51.2 ± 28.4	53.7 ± 23.4	14.256	<0.001
替代器官[n(%)]		?	?	?	22.795	<0.001
?	胃	5(71.4)	27(96.4)	87(98.9)	?	?
?	结肠	0(0)	0(0)	1(1.1)	?	?
?	空肠	2(28.6)	1(3.6)	(0)	?	?
上提路径[n(%)]		?	?	?	3.521	<0.001
?	食管床	7(100)	18(64.3)	59(67.0)	?	?
?	胸骨后	0(0)	10(35.7)	29(33.0)	?	?
手术方式[n(%)]		?	?	?	59.827	<0.001
?	McKeown三切口	2(28.6)	25(89.3)	86(97.7)	?	?
?	经食管裂孔	3(42.6)	0(0)	2(2.3)	?	?
?	胸骨部分劈开	0(0)	2(7.1)	0(0)	?	?
?	空肠间置	2(28.6)	1(3.6)	0(0)	?	?

变量		TLPE组(N＝7)	LPE组(N＝28)	UPE组(N＝88)	χ²值	P值
肿瘤类型		?	?	?	4.999	0.544
?	鳞癌	7(100)	27(96.4)	84(95.5)	?	?
?	梭形细胞肉瘤	0(0)	1(3.6)	0(0)	?	?
?	神经内分泌癌	0(0)	0(0)	3(3.4)	?	?
?	平滑肌肉瘤	0(0)	/0(0)	1(1.1)	?	?
病理T分期		?	?	?	3.158	0.924
?	T0	0(0)	0(0)	4(4.5)	?	?
?	T1	0(0)	2(7.1)	10(11.4)	?	?
?	T2	1(14.3)	4(14.3)	11(12.5)	?	?
?	T3	4(57.1)	16(57.1)	44(50.0)	?	?
?	T4	2(28.6)	6(21.6)	19(21.6)	?	?
病理N分期		?	?	?	2.598	0.857
?	N0	5(71.4)	13(46.4)	45(51.1)	?	?
?	N1	1(14.3)	7(25.0)	25(28.4)	?	?
?	N2	1(14.3)	7(25.0)	14(15.9)	?	?
N3肿瘤完整切除率		0(0)	1(3.6)	4(4.5)	?	?
N3肿瘤完整切除率		?	?	?	8.412	0.281
?	R0切除	6(85.7)	17(60.7)	65(73.9)	?	?
?	R1切除(近端切缘肿瘤残余)	0(0)	3(13.1)	5(5.6)	?	?
?	R2切除(侵犯周围脏器)	1(14.3)	3(13.1)	2(2.3)	?	?
?	R2切除(阳性淋巴结残留)	0(0)	3(13.1)	16(18.2)	?	?
脉管侵犯		1(14.3)	4(14.3)	11(12.5)	0.071	0.965

变量		TLPE组(N＝7)	LPE组(N＝28)	UPE组(N＝88)	χ²值	P值
肿瘤类型		?	?	?	4.999	0.544
?	鳞癌	7(100)	27(96.4)	84(95.5)	?	?
?	梭形细胞肉瘤	0(0)	1(3.6)	0(0)	?	?
?	神经内分泌癌	0(0)	0(0)	3(3.4)	?	?
?	平滑肌肉瘤	0(0)	/0(0)	1(1.1)	?	?
病理T分期		?	?	?	3.158	0.924
?	T0	0(0)	0(0)	4(4.5)	?	?
?	T1	0(0)	2(7.1)	10(11.4)	?	?
?	T2	1(14.3)	4(14.3)	11(12.5)	?	?
?	T3	4(57.1)	16(57.1)	44(50.0)	?	?
?	T4	2(28.6)	6(21.6)	19(21.6)	?	?
病理N分期		?	?	?	2.598	0.857
?	N0	5(71.4)	13(46.4)	45(51.1)	?	?
?	N1	1(14.3)	7(25.0)	25(28.4)	?	?
?	N2	1(14.3)	7(25.0)	14(15.9)	?	?
N3肿瘤完整切除率		0(0)	1(3.6)	4(4.5)	?	?
N3肿瘤完整切除率		?	?	?	8.412	0.281
?	R0切除	6(85.7)	17(60.7)	65(73.9)	?	?
?	R1切除(近端切缘肿瘤残余)	0(0)	3(13.1)	5(5.6)	?	?
?	R2切除(侵犯周围脏器)	1(14.3)	3(13.1)	2(2.3)	?	?
?	R2切除(阳性淋巴结残留)	0(0)	3(13.1)	16(18.2)	?	?
脉管侵犯		1(14.3)	4(14.3)	11(12.5)	0.071	0.965

变量	TLPE组(N＝7)	LPE组(N＝28)	UPE组(N＝88)
总并发症	3(42.9)	7(25.0)	19(21.6)
肺部并发症	0(0)	2(7.1)	9(10.1)
吻合口瘘	2(28.6)	4(14.3)	8(9.1)
喉返神经损伤	0(0)	2(7.1)	8(9.1)
乳糜胸	0(0)	0(0)	2(2.3)
切口感染	0(0)	2(7.1)	0(0)
消化道出血	1(14.3)	/0(0)	0(0)

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